Step 1 of 7 14% PERSONAL INFORMATIONName* First Last Email* Enter Email Confirm Email Phone Number* Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of Birth* MM slash DD slash YYYY Marital Status* Single Married Separated Divorced Widowed Gender* How did you first find out about this program?*Ananda.org websiteEmail(s) received from AnandaEmail(s) received from Expanding LightReferral from member of Ananda FamilyReferral from a friendWeb searchWebsitesSocial MediaConferencePrint AdRepeat EL GuestOtherIf “other”: KARMA YOGA PROGRAM INFORMATIONWhat are your preferred dates for participating in this program?* Have you ever participated in a program similar to the Ananda Karma Yoga Ashram Program before?* Yes No If yes, please specify location and approximate dates* Have you ever stayed at the Expanding Light Retreat?* Yes No If yes, please specify which program and approximate dates Why would you like to be part of Ananda's Karma Yoga Ashram Program?*What, if any, is your previous experience with Ananda?*What is your experience with the spiritual path in general?*The Expanding Light Retreat, as part of Ananda, is dedicated to following the non-sectarian teachings of Paramhansa Yogananda. While we do not proselytize, our spiritual life is dedicated to God and our particular lineage of yoga masters, including Jesus Christ and Paramhansa Yogananda. Is this comfortable for you?* Yes No Please explain why* The Karma Yoga Program is set up to offer people a focused and disciplined ashram experience. When we serve together with a willing and joyful attitude we benefit the most from this program and grow spiritually. For this reason it is important for participants in this Program to attend all daily activities. Are you willing to attend all activities during your stay with us?* Yes No Daily service includes dishwashing (with heavy pots and pans) and housekeeping (cleaning bathrooms, vacuuming, etc.) and gardening. Will you be able to handle this in a responsible and energetic fashion?* Yes No HOUSINGAre you willing to share a small room with bunk beds with one other person (same gender) in our Karma Yoga housing? (Typically we cannot accomodate a private room)* Yes No Are you comfortable with sleeping on the top bunk?* Yes No Do you snore?* Yes No Would you be interested in bringing your own tent to live in during your stay (applicable May through October)?* Yes No OTHER IMPORTANT INFORMATIONAt the heart of Paramhansa Yogananda’s teachings is developing a daily, regular meditation practice. Are you willing to commit to attending one sadhana (Energization exercises, yoga postures and meditation) per day?* Yes No Which style(s) of yoga do you practice and how long (months and/or years) have you been practicing?*Do you practice meditation? If so, how often?* Are you willing to commit to not using marijuana, recreational drugs, or alcohol either on or off the property while you are in the Karma Yoga Program?*We have a zero tolerance policy on this topic. Yes No Do you have a residence to return to at the conclusion of your stay in the Karma Yoga Program? (This includes if for any reason you need to leave the program early.)* Yes No Have you ever been convicted of a felony?* Yes No If yes please elaborate.TRANSPORTATIONDo you have your own transportation to the Karma Yoga Program?* Yes No If not, will you be taking public transportation?* Yes No Please visit our website for more information about tranportation options: https://www.expandinglight.org/who/directions.phpDIET RESTRICTIONSDo you have questions or concerns about your diet? Please elaborate in detail. Important Note: Our kitchen offers a varied selection of vegetarian cuisine daily; we can provide dairy-free and wheat-free alternatives, but we are unable to accommodate all special dietary requirements.*Please provide two references:PERSONAL REFERENCESName* First Last Phone*Work Title* Relationship* Name* First Last Phone*Work Title* Relationship* Please include a resume or work history*Accepted file types: jpg, gif, png, pdf, Max. file size: 391 MB.You must have Medical Insurance during your stay in the Karma Yoga Program. Please provide your medical insurance information. If you do not currently have medical insurance we can refer you to a website to obtain travel insurance during your stay with us. Please bring your insurance card with you for your stay.MEDICAL INSURANCEName of Carrier* Expiration date of policy* MM slash DD slash YYYY Policy number* Deductible* MEDICAL QUESTIONNAIREIt is very important that you answer the following questions completely and truthfully, as your physical, mental and emotional health are important factors in determining how our programs can best work for you. The Karma Yoga Program requires that you participate in a variety of activities—some more strenuous than others. To help us decide if this program is right for you, please answer the questions below. All responses are confidential. Have questions? Please don’t hesitate to contact us at karmayoga@expandinglight.org.Please briefly describe your current overall health.*Describe your history (include dates) of back/spine/neck problems, and indicate if you are currently having any issues. Please be specific. **Describe your history (include dates) of joint problems (knee, hip, shoulder, etc.), including joint repair/replacement surgeries. Please be specific.*When was the last time your blood pressure was checked and was it normal, high, or low?* Describe any history (even if you are just “at risk”) of heart or blood problems*Are you pregnant? If yes, when is your due date?* Please check any of the following difficulties you have had and explain relevant specifics in the next question.* Diabetes Stroke Seizures Eye condition Frequent diziness or falls Osteopenia-Osteoporosis Chronic Headaches Asthma Cancer Anxiety Depression Trauma Abuse PTSD Addiction Substance Abuse Insomnia Overweight Underweight Chemical Sensitivities Other None of the above Please explain the above health conditions you checked off in greater detail and with relevant dates.Do you have other limitations or health concerns? If so, please explain.*Are you currently seeing, or have you seen in the last 5 years, a physician or therapist for any physical or mental/psychological conditions? If yes, what conditions?*If you have any learning disabilities, or other special physical or mental/psychological circumstances, please explain below.*Are you now taking medication for any physical or mental/psychological conditions? If yes, what medications, for which conditions, and how frequently?*If you have asthma medications and/or nitroglycerine, please keep them with you at all times during the course.Have you ever had an alcohol or substance abuse problem? Been in an alcohol or substance abuse program? If yes to either, please explain and give dates.*Do you have a history of mental or physical abuse, trauma, or PTSD? If yes, please explain and give dates.*Do you smoke?*If you do smoke it is essential that you ONLY smoke in designated areas both for the wellness of our guests and because we are in an extremely high fire danger area. Yes No EMERGENCY CONTACT INFORMATIONIn case of an emergency, whom can we contact?Name* First Last Relationship* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone* I hereby certify that the above information is correct to the best of my knowledge, and I will continue taking all medications as prescribed by my health care practitioners(s) while in Ananda's Karma Yoga Ashram Program. (Please sign your name)* During your participation in the program, we will be taking photos and videos of Karma Yogis for marketing purposes. Do we have permission to use any photos and videos of you?* Yes No Untitled 11259Δ
